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NPI Code Detail

MEDICARE: CHAMPION PHYSICAL THERAPY LLC HALLS

MEDICARE: CHAMPION PHYSICAL THERAPY LLC HALLS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
73650169OTHERTNMEDICARE PART B

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11316434764OTHERTNNPI
21013404516OTHERTNNPI
31528555992OTHERTNNPI
41558858902OTHERTNNPI
51396232682OTHERTNNPI
61902393291OTHERTNNPI
81083101448OTHERTNNPI
91083101463OTHERTNNPI
101841787207OTHERTNNPI
111013404409OTHERTNNPI
121285121673OTHERTNNPI
131396232781OTHERTNNPI
141922595388OTHERTNNPI

General Provider Information

NPI Number : 1073771564
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHAMPION PHYSICAL THERAPY LLC HALLS
Provider Business Mailing Address
First Line : 1110 SHAWNEE RD
Second Line :
City : LIMA
State : OH
Zip : 45805-3529
Country : US
Telephone Number : 419-221-6717
Fax Number : 419-222-0507
Provider Business Practice Location Address
First Line : 7228 NORRIS FWY
Second Line :
City : KNOXVILLE
State : TN
Zip : 37918-5744
Country : US
Telephone Number : 865-300-0512
Fax Number :
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT
Name : MR. BRAD C. ROUSH
Credential :
Telephone Number : 419-221-6712
Provider Enumeration Date : 05/30/2008
Last Update Date : 01/23/2019

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